PB2197: PRE-HAEMATOPOIETIC STEM CELL TRANSPLANT DENTAL ASSESSMENT: A SERVICE EVALUATION
Authors: R. Wali, E. Miles, C. Bryant, J. Patel, S. Moosajee, S. Nayani-Low
Journal: HemaSphere (2022)

Background: Complications of haematopoietic stem cell transplant (HSCT) may result from or be exacerbated by inadequate oral preparation of patients prior to transplantation. It is essential that patients referred for HSCT undergo a thorough dental assessment and are deemed “dentally-fit” prior to transplant. Aims: This service evaluation aims to review the referral-to- “dentally-fit” timeline for haematology patients referred for dental assessment prior to planned HSCT at King’s College Hospital. We aim to evaluate the factors that may impact on the timely delivery of haematological care for this cohort of patients. Methods: Retrospective data was extracted from a dedicated database of medically compromised patients and filtered for those referred for the purpose of pre-HSCT dental assessment. Data relating to the demographics, referral to assessment time, dental findings, dental treatment needs and time from referral to establishing a “dentally-fit” status was recorded for pre-HSCT patients with any haematological disease seen in our clinic between 1st January and 31st December 2021. Patients whose HSCT was delayed because of concerns about their oral health were identified, the duration of the delay calculated and the reasons for this identified. Results: 125 patients with haematological disease were referred for pre-HSCT dental assessment between January-December 2021. Gender distribution was 58% (n=72) male and 42% (n=53) female. Age at dental assessment ranged from 19-75 years, with a mean age of 57 years. The haematological diagnoses of this cohort were myeloma 46% (n=58), lymphoma 24% (n=30), leukaemia 18% (n=22), myelodysplastic syndromes 6% (n=8), sickle cell disease 3% (n=4), aplastic anaemia 2% (n=2) and red cell aplasia 1% (n=1). Referrals were made with a provisional HSCT date in 83% of cases. The mean time between referral and dental assessment was 27 days. 43 patients (34%) were diagnosed with dental disease requiring pre-HSCT treatment, 36 (84%) of these required dental extraction. The mean time from referral to acquiring a “dentally-fit” status was 33 days, an additional 10-day healing period was necessary for patients requiring dental extractions. Four (3%) patients had their provisional HSCT date delayed for dental reasons, two were referred late and the 10-day post-extraction healing period of two others extended beyond the date planned. Summary/Conclusion: Very few of our patients experienced a delay in HSCT because of their dental treatment needs, demonstrating the value of timely referral for pre-HSCT dental assessment, which must factor in the need for post-extraction healing periods. To avoid delays in HSCT for future patients, the implementation of a fast-track service within our current patient pathway may improve the management of cases where time to transplant is limited. For the majority of patients our service is effective in providing dental assessment and treatment prior to their proposed HSCT date. Improvements could be made by encouraging our haematology colleagues to refer patients earlier where this is possible and highlighting the need to consider post-extraction healing periods when making a dental referral and planning transplant dates.